Over 11 million smokers are treated in Emergency Departments (ED) for acute respiratory illness (ARI) each year. Smokers seeking treatment for ARI in the hospital ED may be particularly receptive to smoking cessation interventions because of the increased salience of breathing-related, and thus, smoking- related concerns. However, the ED has thus far been under- utilized and under-studied as an environment in which to provide smoking cessation treatment. We aim to take advantage of this teachable moment to intervene with smokers. Smokers seeking emergency treatment for ARI will be recruited in the ED and randomly assigned to one of two interventions for smoking cessation: 1) an intervention modeled after the current Standard-of-Care (SC) as described in the AHCPR guidelines (Fiore et al., 1996) or, 2) an Enhanced Care (EC) intervention. The SC treatment consists of brief physician intervention in the ED based on the AHCPR's "five A's" (ask, assess, advise, assist, arrange follow-up). Extensive environmental and educational supports will be instituted in the ED to ensure implementation of this intervention. The EC treatment builds upon the SC intervention by adding a counseling session with a smoking cessation specialist with telephone follow-up. The EC counseling incorporates biomarker feedback, behavioral skills training, and motivational counseling techniques, which can be tailored to take advantage of heightened health-awareness that subjects will likely experience in this setting. We are not targeting individuals with chronic respiratory illness specifically, but are utilizing the ED setting and symptoms of ARI as a window of opportunity to reach out to smokers who may not otherwise present themselves for smoking cessation treatment. Intervention design and study procedures build upon similar studies we have conducted previously in hospital clinic and ED settings. We will assess physician compliance and implementation of the intervention as well as cessation rates at 1, 3, 6, and 12 months post-treatment. We anticipate significantly higher cessation rates among those given the EC intervention compared to the SC intervention.